Getting everyone else to sign their books

snowfreeze, BSN, RN · Jun 4, 2006

So it seems you have found the reason and the problem, what is your solution?

southern_rn_brat · Jun 6, 2006

In our facility, we realized that med ommissions where at an alarming rate (mostly due to missed signatures). First, we put every nurse through a mini inservice to review the med admin policies and procedures. Then, we made it our habit (as supervisors) to frequently/randomly remind people to check each others' MARs at the end of each shift. I usually wait until just before the next shift comes in and say "What are the three things you are going to ask your relief to check on your MARs?" It not only prompts them to ask for a second pair of eyes but they go back and make sure the signatures, new orders, and pre/post pain assessments are completed appropriately before they hand them over. Last, but not least, we make a copy of any MAR with missing documentation and we have the person responsible fill out the incident report. This is not a disciplinary document, it is a tracking tool and when the nurses fill it out themselves it makes them realize how often it happens and how one missed signature can generate alot more paperwork. Our med ommissions dropped to nearly non-existent after these steps. I have worked the floor in a busy rehab unit for ten years and I know how easy it is to miss something like a signature now and then due to the other overwhelming pressures of the job. Sometimes, its all about raising awareness and building better habits.

That sounds like a great idea! We have the same problem of getting the nurses to sign their MARs. I like the idea of them having to do the incident report.

pardon me while I call the DON :lol2:

vloho · Jun 6, 2006

Yes maybe she can answer the phone while you chart!

Daytonite, BSN, RN · Jun 7, 2006

it was handled different ways in different places.

one place waited until the mars and tars were removed from the books at the end of the month. the assistant don then went through them and put sticky notes with the dates and times that needed signatures on them. these were then placed in a pile on the units and each of the charge nurses was responsible for going through them and checking to make sure they had signed off any spaces they had left.

in another place, the night shift nurses were supposed to check all the signatures and sticky note anything not signed off.

one facility had a senior aide whose job it was to check the charting of the other aides. another facility made it the job of the mds coordinator to get the aides to sign off their charting.

if you don't get some sort of a routine and keep up with it, well. . .you know what will happen. this is definitely a never ending headache.

Drysolong · Jun 26, 2006

I'm still being precepted in my facility of two weeks. The procedure here is that the oncoming nurse checks the MAR to determine if the previous nurse has left any holes(gaps). Per the other nurses, this is new and the procedure changes from time to time. My supervisor trained me to do this BEFORE taking count and accepting keys, so this is what I do. I notice other nurses are already starting not to do it. Being so new (at the facility and a new graduate to boot) I find it to be a good strategy and it doesn't bother me to do it.

StrEssEdX2 · Jun 28, 2006

We just started having the oncoming nurse check the MARS and TARS. The only problem with that is that it is very time consuming and makes the oncoming nurse fall behind and the leaving nurse late getting out.

nurse_clown · Jun 28, 2006

how the heck do you do it? as you know i am on day 5 of my new job as a new unit manager at a ltc facility/sub acute rehab and the biggest issue i see are the gaps. how do you get the nurses who give meds and do treatments and the cna's to make sure the accountability sheets are signed? this is very frustrating. of course this is a new month and i am sure that the nurse manager who was there before me did not do everything because she couldn't of. how do you not get behind in all of the rudundant paper work? how do you deal with cna attitudes? :uhoh21: i have tons of questions but this is all i feel like typing now. lol:nurse:
mrsstraty

just a question in response to that... what happens to all that paperwork? i work in canada and we have a lot of paperwork. mars, treatment records, adl's, bowel routines... how does the ministry keep stats? who reads all of that?

our manager has the same problem with us signing our paperwork. at the end of the month she just looks at the ones that aren't signed and lists them for us. usually, i only have a couple to sign but generally, i'm on top of that. as for cna attitudes, we praise the positive attitudes. sometimes, they have to work "short-handed" because someone calls in sick at the last moment. but the work gets done. we have a message board where we stick up praises and thank yous. as for the negative attitudes... not sure how to deal with that. i usually tell ppl just to relax and get the work done. i'm not a manager and i work the night shift. lucky me, i don't have to worry too much about all that.

banditrn · Jul 11, 2006

In our LTC facility, the nite nurse is supposed to do a weekly audit.

It's great to expect it all to be done on a daily basis, but even on nites I find that sometimes I'm so busy that I don't have time to chart during the shift, and must sit down and do all my 'busy work' at the end - sometimes it will end up taking 1 to 2 hours, because we're a skilled facility. The facility doesn't care if we work OT - but I do. I'm supposed to be working an 8 hour shift, but it's usually 9 to 10 hours - and I'm TIRED of it.

nurse_clown · Jul 12, 2006

in our ltc facility, the nite nurse is supposed to do a weekly audit.
it's great to expect it all to be done on a daily basis, but even on nites i find that sometimes i'm so busy that i don't have time to chart during the shift, and must sit down and do all my 'busy work' at the end - sometimes it will end up taking 1 to 2 hours, because we're a skilled facility. the facility doesn't care if we work ot - but i do. i'm supposed to be working an 8 hour shift, but it's usually 9 to 10 hours - and i'm tired of it.

sorry about all the dumb questions but.... what's a "skilled facility"?? i work in long term care but i doubt our unit is a skilled one. we have to request outside help to start an i.v. even though i start i.v's from difficult veins at my other job. i think that's a little weird and a waste of $$

achot chavi · Jul 12, 2006

One has to be very idealistic to expect everyont to sign everything the way it is supposed to- but we are humans and even I might miss a signature now and again. I have successfully cut down on missing signatures by

first step- have an inservice or staff meeting explaining the importance of signing. I always explain to nurses and CNA's alike that at home noone checks to see if youve done laundry, cooked nutritious meals, cut the kids fingernails etc, but we are not at home and we are under constant review. Our signature is like our recipt that we gave the proper care. It isn't about not beleiving, it is abour accountability. Just like you wouldnt leave a grocery or shoe store without a receipt, you can't leave work without accounting for your responsibilities with a signature (or an amount on your I and O's). then I make it clear that I will be auditing the MARs and treatment folders for missing signatures with zero tolerance attitude. (while also explaining that even I forget a signature so noone should take it personally). The rule is you can't sing out till youve signed!

Second step- I wait a couple of weeks then I audit (with a preprinted table to point our the missing signatures- date, time, name of pt, name of med, etc)

I post the audit keeping in nonpersonal -no punishments or even a cross look

third step I follow up a week later with a second audit. this time repeat offenders of many missing signatures get a personal letter from me including a request to be careful in the future or I will have to write a letter to their personal file.

fourth step if necessary, I write a letter documenting the missing signatures and keep a copy for the personal file

I fhte offending nurse or cna doesnt get the message that this is important than i have to consider other aspects of her job and determine if she or he is worth keeping on board

I keep good humor throughout and try to emphasize that while no one is perfect, we all have to stay on our toes and even help each other!

LOL

banditrn · Jul 12, 2006

sorry about all the dumb questions but.... what's a "skilled facility"?? i work in long term care but i doubt our unit is a skilled one. we have to request outside help to start an i.v. even though i start i.v's from difficult veins at my other job. i think that's a little weird and a waste of $$

the 'skilled' title means that those patients require a higher level of care than the regular ltc residents. they may have iv's, feeding tubes, trach's, etc. the facility makes more money on those patients, so they fight to keep them at the 'skilled' level.

with those patients, charting must be done every shift to assess their need for that level.

CapeCodMermaid, RN · Jul 12, 2006

sorry about all the dumb questions but.... what's a "skilled facility"?? i work in long term care but i doubt our unit is a skilled one. we have to request outside help to start an i.v. even though i start i.v's from difficult veins at my other job. i think that's a little weird and a waste of $$

if you accept medicare a or managed care patients you are a skilled facility